First responders require physical fitness to perform dangerous tasks in unpredictable environments. To promote physical fitness among first responders, many agencies use a peer fitness leader (PFL) approach; however, resources for the fitness, wellness, and health of PFLs are often minimal. This study\'s purpose was to investigate the effectiveness of a training workshop to increase PFL\'s training knowledge and coaching comfort (CC). Thirty-six PFLs (Experience: 14.6 ± 9.1 yrs; Age: 41.0 ± 9.8 yrs; BMI: 28.9 ± 7.0 kg·m-2) attended a one-day workshop. Paired samples t-tests assessed for differences between baseline and post-assessment knowledge scores. Pearson correlations described the bivariate relationship between baseline and post-assessment knowledge scores. Wilcoxon\'s Signed Rank Test determined associations between baseline and post-workshop CC variables. Spearman\'s Rho correlations described bivariate relationships between baseline and post-assessment values for each CC category. Kendall\'s Rank correlations investigated relationships between knowledge scores and total perceived CC for pre- and post-workshops. Statistical significance was set at p < 0.05. Results indicated an improvement from the baseline knowledge score (6.08 ± 1.46 points) and post-workshop knowledge score (7.03 ± 0.94 points); (t (25) = 3.85; p < 0.001). Similar trends were observed for all CC measures (Z > -3.42; p < 0.001). Differences were not observed between pre-workshop total CC and knowledge scores (τ = -0.03; p = 0.81) or following workshop completion (τ = -0.04; p = 0.76). Participants demonstrated varying exercise knowledge and CC, highlighting inconsistencies in exercise standards within first responder occupations. This investigation suggests the proposed pedagogy design may be a solution for agencies with limited budgets.

This review aimed to identify the post-graduation training pathways available for both clinicians and trainers in the assessment and diagnosis of Autism Spectrum Disorder (ASD). The study was guided by two research questions: What is known about ASD-specific educational, training, or other pathways available to support clinicians of any discipline, post-graduation, to meet the required expertise relevant to assessments of ASD concerns? What is known about the educational pathways available to clinicians seeking to provide training to other clinicians, post-graduation, in the assessment of ASD concerns? A scoping review was undertaken with searches completed across five databases (PubMed, PsycINFO, PsycEXTRA, ERIC and CINAHL). A Google search strategy was also executed using the \"advanced\" search function. Eligible records were literature, written in English, that examined post-graduation training and/ or education of clinicians to assess and/ or diagnose ASD. Fourteen relevant records were identified. Post-graduate training has the potential to enhance clinician confidence and service provision in ASD assessment and diagnosis. System-wide training approaches show promise in building large-scale, diagnostic capacity and the use of tele-mentoring offers a cost-effective, convenient mode of training delivery. A lack of evidence to support ASD diagnostic training pathways was found and may pose a challenge for clinicians and service users. The limited evidence found suggests that high quality research will be fundamental in determining how to build clinician capacity in ASD assessment and diagnosis and to ascertain whether training pathways are a necessary component.

BACKGROUND: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care.
OBJECTIVE: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic.
METHODS: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania\'s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick\'s model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation.
RESULTS: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care.
CONCLUSIONS: The REaCH training program is feasible, acceptable, and effective in changing trainees\' behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.

Naloxone is a life-saving medication that reverses opioid overdose; naloxone can be provided on a \'take-home\' basis so naloxone can be administered outside of the health-care setting. The Overdose Response and Take Home Naloxone (ORTHN) project established a model of care for take-home naloxone (THN) interventions across alcohol and other drug and harm reduction services in NSW, Australia. This paper evaluates the staff training and credentialing program, and examines staff attitudes and perspectives regarding the provision of THN interventions in these settings.
Staff across seven services were trained through a \'train-the-trainer\' credentialing model to deliver ORTHN, including naloxone supply. Staff were surveyed regarding their experience, attitudes and knowledge on THN prior to and after training, and after 6 months. At the 6 months follow up, staff were asked about the interventions they provided, barriers and enablers to uptake, and opinions regarding future rollout.
A total of 204 staff were trained and credentialed to provide the ORTHN intervention. Most (60%) were nurses, followed by needle syringe program workers and allied health/counsellors (32%). Linear and logistic regression analyses indicated that the training program was associated with significant improvements in staff knowledge and attitudes towards overdose and THN; however, only attitudinal improvements were maintained over time. There were high rates of staff satisfaction with the ORTHN intervention and training.
The ORTHN program is \'fit for purpose\' for broad implementation in these settings. A number of potential barriers (e.g. time, medication and staffing costs) and enablers (e.g. peer engagement, regulatory framework for naloxone supply) in implementing THN interventions were identified.

UNASSIGNED: Minimal formal training exists in teaching invasive bedside procedures during Internal Medicine (IM) residency despite the large role trainees have in instructing junior colleagues.
UNASSIGNED: We investigated if using a Procedural Objective Structured Teaching Encounter (PrOSTE) to disseminate a novel method for teaching procedures would improve supervising residents\' (n = 7) ability to teach ultrasound-guided peripheral IV\'s (USGIV) to incoming interns (n = 67) at a single, large academic IM residency. Supervising residents were assigned to receive the PrOSTE training versus standard procedure training, and then, both groups instructed incoming interns. The impact of the PrOSTE was measured by participant surveys, observed changes in teacher behavior, and performance of incoming interns on a USGIV blinded assessment station.
UNASSIGNED: PrOSTE-trained residents reported high levels of satisfaction with the session and demonstrated increased desirable behaviors when teaching procedures. There was no statistical difference in incoming intern performance when placing USGIVs between intervention and standard groups (81.0% vs 74.8% items correct; difference 6.2; SD = 12.4; p = 0.22).
UNASSIGNED: The PrOSTE is a feasible, well-received tool for training supervising residents in our novel teaching framework, as demonstrated in this pilot study. Despite not showing a difference in learner performance, qualitative data suggests the impact of the PrOSTE would be even greater in a more controlled teaching environment. Using a PrOSTE to deliver this teaching framework has broad applicability to any IM residency, and the tenets can be used with any bedside invasive procedure with an effective task trainer.

Faculty development (FD) is an element critical to the professional growth of medical educators and a necessary component in developing effective educators. FD offerings are prevalent across academic institutions; however, faculty report they are unable to participate in these initiatives due to time limitations and competing priorities. The snippet FD approach can address these concerns but requires training for FD providers to be effectively used.
This snippet train-the-trainer workshop was presented to approximately 310 physician and nonphysician medical educators at a national medical education conference. The session incorporated multiple teaching modalities (e.g., lecture, demonstrations, structured small-group snippet development groups, and large-group debriefs). A 14-item Likert-scale survey was used to obtain participant evaluations. Narrative feedback was collected using constructed response items.
Ninety-five percent of respondents (125 of 132) planned to use snippets as an FD strategy at least once per year, with 38% (50 of 132) noting they planned to use snippets at least four times per year. Respondents indicated that FD snippets could positively impact educational practices (94%) and that the session was a valuable use of their time (94%), as well as expressing interest in a snippet repository (90%).
A brief FD train-the-trainer workshop for snippets can successfully prepare FD providers to create and use this approach.

BACKGROUND: A novel multi-site \'train the trainer\' point-of-care ultrasound (POCUS) training course was designed to better meet the graduate medical education learning needs of a geographically dispersed consortium of 16 community-based Michigan emergency medicine (EM) residency programs. The specific aim of this study was to explore the feasibility of using volunteer EM physicians who were novices with ultrasound techniques as instructors for a POCUS course. Additionally, the authors evaluated the effectiveness and consistency of a POCUS course delivered over multiple sites to enhance EM residents\' ultrasound knowledge and skill acquisition.
METHODS: For the initial session, the lead instructor conducted a focused two-hour course with the novice instructors. A subsequent four-hour session was then repeated for EM residents whereby the aforementioned novice instructors provided the hands-on instruction. The residents were given 10-item pre- and 20-item post-course knowledge tests to gauge the effectiveness of the instruction model. After the course, a satisfaction survey was administered to the resident participants and a qualitative open-ended survey to the volunteer EM physicians who served as instructors.
RESULTS: Forty-two EM residents from 11 different residency programs attended at one of the three courses that were offered. After adjustments for size differences in the pre- and post-training tests, 35 (87.5%) of total sample resident learners\' scores proportionately increased from pre- to post-test scores, with five (11.9%) other residents maintaining their pre-course score levels and only two (4.8%) residents experienced a post-score decline. In addition, resident participants responded favorably to a post-course summary evaluation with an average response of 4.8 (0-5 Likert scale) demonstrating overall satisfaction with the course. In the separate qualitative survey given to instructors, comments consistently conveyed a perceived benefit for the volunteer EM physicians.
CONCLUSIONS: The evaluation of this novel model supports the feasibility of the \'train the trainer\' program. It provides a proof of principle that train the trainer model can be implemented for POCUS training courses. Despite the small sample size, our results show an increase in the pre- to post-test scores among most participating residents. This model provides an additional option for EM residency program educators to consider when developing their POCUS training courses across multiple GME settings.

Objective: Demands for a stronger competence orientation of specialty postgraduate medical training require the expansion of the didactic qualifications of those responsible for postgraduate medical training. In the context of the foundation of the Berlin competence center for postgraduate general practice training, a train the trainer basic seminar was designed together with the Berlin chamber of physicians. The seminar aims to convey formal-legal aspects in close connection with the development of didactic competences of the general practice trainers. This article presents the didactic concept, focal points and the schedule of the one-and-a-half-day seminar to be able to adapt it to one\'s own context. Methodology: After the seminars, participants filled out an evaluation form. The questionnaire included the subjective experiences of increased competence, the relevance of the contents, and the satisfaction with the structure and methods of the seminar. The data were analyzed descriptively. Results: Since June 2018, 46 general practice trainers have participated in one of three train the trainer seminars. 97.6% of the participants were very satisfied or satisfied with the overall seminar and felt that the timeframe was right, 92.7% would recommend the seminar to colleagues. 68.3% fully agreed that by attending the seminar they were able to improve their didactic skills, 90% were confident that they could integrate what they had learned into their work as general practice trainers. 85.4% stated that they had reflected on their role as trainers. In particular, the atmosphere, the high degree of interactivity and the protected framework for collegial exchange were positively emphasized. Conclusion: Together with the Berlin chamber of physicians, we succeeded in designing a train the trainer seminar which, on the one hand, met the needs of the general practice trainers for clarification of formal-legal questions of their further training activities and, on the other hand, allowed the further development of didactic skills. At the moment, a modular program is being planned in order to give general practice trainers the opportunity to expand their didactic competence and regularly exchange ideas with colleagues.
Zielsetzung: Forderungen nach einer stärkeren Kompetenzorientierung der Facharzt-Weiterbildung erfordern den Ausbau didaktischer Qualifikationen der Weiterbildungsbefugten. Im Rahmen der Gründung des Berliner Kompetenzzentrums Weiterbildung wurde gemeinsam mit der Landes-Ärztekammer ein Train the Trainer-Basis-Seminar für Weiterbildungsbefugte in der ambulanten Versorgung konzipiert. Ziel des Seminars ist die Vermittlung formal-rechtlicher Aspekte in enger Verzahnung mit dem Ausbau didaktischer Kompetenzen der Befugten. Das didaktische Konzept, Schwerpunkte und der Zeitplan des anderthalbtägigen Seminars werden dargestellt, um es für den eigenen Kontext adaptieren zu können. Methodik: Im Anschluss an die Seminare füllten die Teilnehmenden einen Evaluationsbogen aus. Erfragt wurde der subjektiv erlebte Kompetenzzuwachs, die Relevanz der Inhalte und die Zufriedenheit mit der Struktur und den Methoden der Veranstaltung. Die Angaben wurden deskriptiv ausgewertet. Ergebnisse: Seit Juni 2018 haben 46 Befugte an einem von drei Train the Trainer-Seminaren teilgenommen. 97,6% der Teilnehmenden waren mit der Gesamtveranstaltung sehr zufrieden bzw. zufrieden und empfanden den zeitlichen Rahmen als genau richtig, 92,7% würden die Veranstaltung Kolleg*innen weiterempfehlen. 68,3% stimmten voll zu, dass sie durch den Besuch des Seminars ihre didaktischen Fertigkeiten ausbauen konnten, 90% waren zuversichtlich, dass sie Erlerntes in ihre Tätigkeit als Befugte integrieren können. 85,4% gaben an, ihre Rolle als Weiterbildungsbefugte reflektiert zu haben. Insbesondere die Atmosphäre, der hohe Grad an Interaktivität sowie der geschützte Rahmen zum kollegialen Austausch wurden positiv hervorgehoben. Schlussfolgerung: Es ist gelungen, gemeinsam mit der Landes-Ärztekammer ein Train the Trainer-Seminar zu konzipieren, welches einerseits den Bedürfnissen der Befugten nach Klärung formal-rechtlicher Fragen ihrer Weiterbildungstätigkeit gerecht wurde als auch den Ausbau didaktischer Fertigkeiten realisieren ließ. Momentan wird ein modular strukturiertes Aufbau-Programm geplant, um Befugten in regelmäßigen Abständen die Gelegenheit zum didaktischen Kompetenzausbau und kollegialen Austausch zu geben.

UNASSIGNED: There is overwhelming evidence to support the promotion of physical activity in adults in terms of benefits to well-being, physical and mental health. Physical activity guidelines suggest that adults should accumulate at least 150 min of moderate to vigorous physical activity per week. In Ireland, the majority of adults do not achieve these guidelines, with costs to health and economy. \'Move for Life\' (MFL) employs behavioural change techniques delivered by an instructor and peer mentor, using a train-the-trainer (cascade) model. This study will conduct a feasibility cluster randomised controlled trial of the MFL intervention for modifying physical activity behaviours in inactive adults aged 45 years and older.
UNASSIGNED: The trial is set in eight Local Sports Partnership (LSP) hubs that have structured physical activity programmes. The hubs are the units of randomisation (clusters), and individuals are the units of analysis (participants). Eligible participants will contact one of the hubs, with each hub running four physical activity programmes. Each programme requires between 12-15 inactive adults, resulting in 48-60 participants per hub. Allowing for 20% dropout rate, an additional 96 people will be recruited giving a maximum sample of 576. The hub will be randomised: true control, usual programme or MFL intervention. The true control group will be given information about physical activity but will not be included in a programme for the duration of the trial; the intervention will involve the instructor training one (or more) of the participants to be a peer mentor using an educational toolkit; and usual care groups will have physical activity classes delivered as normal. Baseline data will collect physical activity measures and follow-up measurements will be obtained at 3 and 6 months. All participants will be asked to wear a device for measuring activity on the thigh (activPAL) for 7 days before commencing the programme and at 3 and 6 months. The primary objective of the study is to investigate if it is feasible to deliver the intervention and collect data on moderate to vigorous physical activity (MVPA) on all participants, thereby providing valuable information to guide sample size calculation for a future, more definitive trial.
UNASSIGNED: ISRCTN11235176.

Objectives. Distracted driving is a major public health issue in the United States. In response to requests from high school students participating in a university-based initiative, the authors describe the collaborative development and implementation of a curriculum designed to address distracted driving behaviors among students in four high-needs school districts in the northeastern United States. Method. The curriculum integrates current statistics on distracted and drowsy driving and three interactive learning stations: driving while distracted, walking while distracted, and driving while drowsy. Pre- and postsurveys were conducted to collect student driving data, assess student satisfaction with the program, and assess their likelihood of speaking up as a passenger in a high-risk situation. Results. The majority of students reported that they learned new information and would recommend the program to others. A Wilcoxon signed-rank test showed that students were more likely to speak up as a passenger with a distracted or drowsy driver (p < .001) after the program. Conclusion. This experience demonstrates a voluntary, multidisciplinary, university-based collaboration in the development of a novel public health education initiative. Based on the success of this phase, school districts elected to participate in Train the Trainer sessions to continue the program within their local high-needs school district.